Hypothyroidism incidence after multimodality treatment for stage III and IV squamous cell carcinomas of the head and neck

Colevas, A.Dimitrios; Read, Richard; Thornhill, John; Adak, Sudeshna; Tishler, Roy; Busse, Paul; Li, Yi; Posner, Marshall

doi:10.1016/S0360-3016(01)01688-1

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Volume 51, Issue 3 , Pages 599-604, 1 November 2001

Hypothyroidism incidence after multimodality treatment for stage III and IV squamous cell carcinomas of the head and neck

A.Dimitrios Colevas, M.D.
- Head and Neck Oncology Program, Dana-Farber Cancer Institute, Boston MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Reprint requests to: A. Dimitrios Colevas, M.D., Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, National Cancer Institute, Executive Plaza North, Room 7131, 6130 Executive Blvd., Rockville, MD 20852-7426. Tel: 301 435-9128; Fax: 301 402 0428
Richard Read, B.A.
- Head and Neck Oncology Program, Dana-Farber Cancer Institute, Boston MA, USA
John Thornhill, B.A.
- Head and Neck Oncology Program, Dana-Farber Cancer Institute, Boston MA, USA
Sudeshna Adak, Ph.D.
- Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA
Roy Tishler, M.D., Ph.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Paul Busse, M.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Yi Li, Ph.D.
- Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA
Marshall Posner, M.D.
- Head and Neck Oncology Program, Dana-Farber Cancer Institute, Boston MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Received 18 December 2000; received in revised form 13 April 2001; accepted 19 May 2001.

Abstract

Treatment of head-and-neck cancer patients with surgery, radiotherapy (RT), and chemotherapy has been associated with posttherapy hypothyroidism (HT). We evaluated the rate of posttherapy HT in patients with locally advanced squamous cell carcinoma of the head and neck, treated with multimodality therapy to determine which factors might predict this condition and at what interval the condition developed.

We reviewed the prospectively collected thyroid function data of patients treated with sequential chemotherapy, RT, and neck dissection. The incidence of posttherapy HT was estimated. The patient, tumor, and treatment factors possibly associated with HT were evaluated.

Of 203 patients, 118 had data adequate for evaluation. HT developed in 45% at a median of 24.4 months after therapy. HT occurred in 14% and 27% of patients at 6 months and 1 year after treatment, respectively. Univariate and multivariate analyses of sex, age, RT dose, RT fractionation, T and N stage, tumor site, and neck dissection failed to identify a clinically relevant risk factor.

A high number of patients undergoing aggressive organ-sparing multimodality therapy for advanced squamous cell carcinoma of the head and neck are at risk for subsequent HT. We recommend that all patients definitively irradiated to the head and neck region undergo frequent serum thyroid-stimulating hormone screening for HT, beginning 6 months after RT.